• Archives of Plastic Surgery
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• 제36권5호
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• pp.617-622
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• 2009

Purpose: Endoscopic transnasal correction of the blowout fractures has many advantages over other techniques. But after removal of packing material, there were some patients with recurrence of preoperative symptoms. Authors tried to make a quantitative anterograde analysis of orbital volume change over whole perioperative period which might be related with recurrence of preoperative symptoms. Methods: 10 patients with pure medial wall fracture(Group I) and 10 patients with medial wall fracture combined with fracture of orbital floor(Group II) were selected to evaluate the final orbital volume change, who took 3 CT scans, pre-, postoperative and 4 months after packing removal. By multiplying cross - section area of orbit in coronal view with section thickness, orbital volume were calculated. Then, mean orbital volume increment after trauma, mean orbital volume decrement after endoscopic correction and volume increment after packing removal were found out. And we tried to find correlations between type of fracture, initial correction rate and final correction rate. Results: The mean orbital volume increment of the fractured orbits were 7.23% in group I and 13.69% in group II. After endoscopic surgery, mean orbital volume decrement were 11.0% in group I and 12.46% in group II. Mean volume increment after packing removal showed 3.10% in group I and 6.50% in group II. The initial correction rate(%) showed linear correlation with final correction rate(%) after packing removal. And there were negative linear correlation between increment percentage of orbital volume by fracture and final correction rate(%). Conclusion: Orbital volume was proved to be increasing after removal of packing or foley catheter and it was dependent upon type of fracture. Overcorrection should be done to improve the final result of orbital blowout fracture especially when there are severe fracture is present.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제32권6호
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• pp.558-562
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• 2010

Sinusitis has been reported as a complication of sinus lift surgery. Obstruction of the sinus outflow tract by mucosal edema and particulate graft material may result in sinusitis. Two main surgical procedures have been proposed for the treatment of associated infectious complications; inferior meatal antrostomy and functional endoscopic sinus surgery through transnasal approach. We performed superior lateral wall antrostomy through introral approach in patient suffering from the sinusitis after sinus floor augmentation and implant installation. This procedure permitted easier access to the maxillary sinus for treat sinusitis caused by sinus lifting.

• 대한두개안면성형외과학회지
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• 제20권6호
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• pp.347-353
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• 2019

Most orbital surgeons believe that it's difficult to restore the primary orbital wall to its previous position and that the orbital wall is so thin that cannot be firmly its primary position. Therefore, orbital wall fractures generally have been reconstructed by replacing the bony defect with a synthetic implant. Although synthetic implants have sufficient strength to maintain their shape and position in the orbital cavity, replacement surgery has some drawbacks due to the residual permanent implants. In previous studies, the author has reported an orbital wall restoring technique in which the primary orbital wall fragment was restored to its prior position through a combination of the transorbital and transantral approaches. Simple straight and curved elevators were introduced transnasally to restore the orbital wall and to maintain temporary extraorbital support in the maxillary and ethmoid sinus. A transconjunctival approach provided sufficient space for implant insertion, while the transnasal approach enabled restoration of the herniated soft tissue back into the orbit. Fracture defect was reduced by restoring the primary orbital wall fragment to its primary position, making it possible to use relatively small size implant, furthermore, extraorbital support from both sinuses decreased the incidence of implant displacement. The author could recreate a natural shape of the orbit with the patient's own orbital bone fragments with this dual approach and effectively restored the orbital volume and shape. This procedure has the advantages for retrieving the orbital contents and restoring the primary orbital wall to its prior position.

• 대한두개안면성형외과학회지
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• 제24권4호
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• pp.174-178
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• 2023

Background: This study aimed to identify the location of the optic foramen in relation to the anterior sphenoid sinus wall, which is essential information for surgeons in planning and performing endoscopic transnasal surgery. Methods: Computed tomography scans of 200 orbits from 100 adult patients with no abnormalities were examined. The results included the location of the optic foramen in relation to the anterior sphenoid sinus wall and the distance between them, as well as the distance from the optic foramen and the anterior sphenoid sinus wall to the carotid prominence in the posterior sphenoid sinus. Results: The optic foramen was anterior to the anterior sphenoid sinus wall in 48.5% of orbits, and posterior in the remaining 51.5%. The mean distance from the optic foramen to the anterior sphenoid sinus wall was 3.82±1.25 mm. The mean distances from the optic foramen and the anterior sphenoid sinus wall to the carotid prominence were 7.67±1.73 and 7.95±2.53 mm, respectively. Conclusion: The optic foramen was anterior to the anterior wall of the sphenoid sinus in approximately half of the orbits examined in this study, and posterior in the remaining half. The mean distance from the optic foramen to the anterior sphenoid sinus wall of the sphenoid sinus was 3.82±1.25 mm.

• Journal of Yeungnam Medical Science
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• 제40권1호
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• pp.96-101
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• 2023

The endoscopic endonasal approach (EEA) to the craniovertebral junction (CVJ) has recently been considered a safer alternative and less invasive approach than the traditional transoral approach because the complications associated with the latter are avoided or minimized. Here, we present two challenging cases of CVJ pathologies. The first case involved os odontoideum associated with anterior displacement of the occipitocervical junction where the EEA was used, followed by C0-C1-C2 fusion using a posterior approach to decompress the CVJ, and was complicated by rhinorrhea and Candida albicans meningitis. The second case involved basilar invagination with syringomyelia previously treated using a posterior approach, where aggravation of neuropathic symptoms required combined treatment with EEA and occipitocervical fusion of C0-C2-C3-C4, with the postoperative course challenged by operative site infection requiring drainage with debridement and antibiotic therapy. The EEA is an alternative approach for accessing the CVJ in well-selected patients. Knowledge of EEA complications is crucial for the optimal care of patients.

• Archives of Plastic Surgery
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• 제50권1호
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• pp.54-58
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• 2023

Patients with Crouzon syndrome have increased risks of cerebrospinal fluid rhinorrhea and meningoencephalocele after LeFort III osteotomy. We report a rare case of meningoencephalocele following LeFort III midface advancement in a patient with Crouzon syndrome. Over 10 years since it was incidentally found during transnasal endoscopic orbital decompression, the untreated meningoencephalocele eventually led to intermittent clear nasal discharge, frontal headache, and seizure. Computed tomography and magnetic resonance imaging demonstrated meningoencephalocele in the left frontal-ethmoid-maxillary sinus through a focal defect of the anterior cranial base. Through bifrontal craniotomy, the meningoencephalocele was removed and the anterior cranial base was reconstructed with a pericranial flap and split calvarial bone graft. Secondary frontal advancement was concurrently performed to relieve suspicious increased intracranial pressure, limit visual deterioration, and improve the forehead shape. Surgeons should be aware that patients with Crouzon syndrome have the potential for an unrecognized dural injury during LeFort III osteotomy due to anatomical differences such as inferior displacement and thinning of the anterior cranial base.

• Journal of Korean Neurosurgical Society
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• 제39권5호
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• pp.329-334
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• 2006

Objective : In selected cases, the transsphenoidal approach[TSA] can be extended anteriorly to the tuberculum sellae, chiasmatic sulcus, and planum sphenoidale to obtain direct exposure of the suprasellar cisterns and its contents. We applied this modification of the TSA to various lesions of the presellar and suprasellar areas. We evaluate our clinical experience of this technique and review the related literature. Methods : From 1999 to 2004, we used the transsphenoidal supradiaphragmatic intradural approachs[TSIAs] in 9 patients who had various lesions at the pre- and suprasellar regions. Concomitant presellar extension of the bone window was performed with the sublabial or transnasal transseptal transphenoidal techniques. After removal of the lesions, sellar or anterior cranial floor was repaired with silicone plate substitute. Results : The TSIAs have been applied in the following cases : four tuberculum sellae meningiomas, two craniopharyngiomas, two Rathke's cleft cysts, and one non-functioning macroadenoma. The complications were one case of visual acuity decrease and one cerebrospinal fluid rhinorrhea. Conclusion : The TSIA is easily applicable through a minor modification of the standard TSA. It is suitable for removing lesions located in the presellar and suprasellar area adjacent to the pituitary stalk with minimal brain manipulation and decreased morbidity.

• 대한두개안면성형외과학회지
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• 제10권1호
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• pp.1-6
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• 2009

Purpose: This study presents a classification of pure medial and inferior blow-out fracture, and confirms the relationship between the types of fractures, postoperative complications and operative methods. Methods: Sixty patients were treated by transnasal endoscopic reduction with $Medpor^{(R)}$ implantation through subciliary incision and foley catheter insertion into maxillary sinus was done if there was extensive orbital floor fracture. Fractures were classified by number of coronal sections from posterior margin of fossa for lacrimal sac to orbital apex in CT. Type I is defined when the medial wall fracture is over 50% and inferior wall fracture below 50%. Type II, when below 50% medial wall fracture and over 50% floor fracture were present. If there were both over 50%, it was classified as Type III and both below 50% for Type IV. Extreme fracture involving orbital buttress was Type V and postoperative findings in all patients were examined. Results: Type I and V were most common and preoperative findings were more likely to present according to extent of inferior fracture. Diplopia remained in 2 cases after additional insertion of foley catheter, but enophthalmos over 2 mm were presented in 3 cases and diplopia in 3 cases were observed who were not treated with foley catheter. Conclusion: Postoperative complications were increased according to extent of fracture, especially buttress involvement. Additional insertion of foley catheter proved its effectiveness in decreasing postoperative complications.

• Journal of Yeungnam Medical Science
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• 제24권1호
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• pp.79-84
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• 2007

Sphenoid sinus aspergillosis is notorious for its serious complications, such as permanent cranial nerve deficits and possible death. The most common associated symptoms are headache, followed by visual changes, and cranial nerve palsies. Because of an insidious onset, frequently resulting in missed and delayed diagnosis, sphenoid sinus aspergillosis is a potentially lethal medical condition. We report a case of visual loss secondary to isolated sphenoid sinus aspergillosis. A 69-year-old man presented to our hospital with the complaint of headache. The headache started one year previously and was described as severe dull pain localized bilaterally to the temporo-orbital region. The patient took daily NSAIDs for the pain. The neurological examination was normal. The MRI of the brain showed a left sphenoid sinusitis. A transnasal endoscopic superior meatal sphenoidotomy was performed. Aspergillosis was confirmed after a surgical biopsy was obtained. The patient was discharged from hospital without antifungal therapy. One month later, the patient complained of headache and loss of vision bilaterally. The orbital MRI showed a left cavernous sinus and bilateral optic nerve invasion. The loss of visions was permanent. In our case, the diagnosis was delayed; antifungal agents were not administered after surgery and the patient lost his vision as a result. Therefore, early diagnosis and proper treatment are important. Although the treatment of an invasive type of aspergillus has not been established, surgical removal of a nidus and aggressive antifungal therapy are recommended.

• 대한기관식도과학회:학술대회논문집
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• 대한기관식도과학회 1983년도 제17차 학술대회연제순서 및 초록
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• pp.18.3-19
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• 1983

후비공 폐쇄는 협비막의 과열부전, 협인두막의 지속적 잔존, Olfactory pit의 발생시 불완전 등의 선천성 원인과, 매독디프테리아, 수술 후 또는 외상 등으로 오는 후천성으로 나눌 수 있으며 선천성인 경우에는 두부, 심장, 소화기 계통에 여러 가지 기형이 동반되기도 한다. Johann Roedere (1755년)은 이 질환의 예를 최초로 보고하였으며 Emmert (1853년)가 골성 폐쇄를 트로카를 이용하여 처음 수술을 시도한 이래 , 비강내, 구개, 상악동, 그리고 비중격을 통한 수술 방법이 제시되어 왔으나 이중 경주개 경유법이 술후 재협착 빈도가 가장 적고 또 수술시 폐쇄부의 확인이 용이하여 가장 널리 이용되고 있다. 저자들은 선천성 양측 부분적 골부 후비공 폐쇄를 보인 11세 남아와 선친성 우측 완전 골막부 후비공 폐쇄와 좌측 부분적 골막부 후비공 폐쇄와 좌측 부분적 골막부 후비공 폐쇄를 보인 9세 여아에서 경구개 경유법으로 치험하였기에 문헌적 고찰과 함께 보고하는 바이다.